Learn multiple sclerosis with the power of comics

This Medcomic highlights some of the main features of multiple sclerosis (MS). Although the exact cause of MS is unknown, the disease is thought to occur as an immune-mediated attack on the central nervous system (CNS). As you can see in the illustration, the white blood cells are attacking the neuron and causing inflammation, demyelination, and axonal degeneration that can manifest through a wide variety of signs and symptoms. The age of onset for MS is usually between 15 and 50 years of age. It is the most common neurological disease causing permanent disability in young adults and is thought to affect more than 2.3 million people worldwide.

People with MS may experience paresthesias, blurred vision, optic neuritis (painful unilateral vision loss), clumsiness, muscle weakness, cognitive decline, and urinary dysfunction. Unfortunately, the neuron in the cartoon is also experiencing some of these symptoms. The Lhermitte sign is elicited when neck flexion produces electric shock-like sensations down the back and limbs.

There are four typical patterns of progression for MS. Clinically isolated syndrome (CIS) is the first attack of a disease that does not yet meet the full criteria for a diagnosis of MS. People who experience this episode may or may not go on to develop MS. Relapsing-remitting MS (RRMS) consists of exacerbations that alternate with full or partial recovery. This is the most common type of MS. Primary progressive MS (PPMS) is characterized by a gradual worsening of disability without remissions, although patients may experience occasional plateaus in the disease course. Secondary progressive MS (SPMS) begins with a relapsing-remitting pattern followed by a gradual worsening of neurologic function, with or without relapses.

Current treatment options for MS include corticosteroids for severe exacerbations and disease-modifying agents that can delay or prevent exacerbations (e.g., glatiramer acetate, beta interferons 1a and 1b). Supportive care is also warranted to treat specific symptoms.

Could we be closer to developing therapies that preserve cognitive function in patients with MS? New research published in The Journal of Neuroscience suggests so. The team behind the study, led by Dr. Matthew Bellizzi of the University of Rochester, performed tests on mice affected by an MS-like disease called experimental autoimmune encephalomyelitis (EAE). They focused on the mice’s hippocampus, an area of the brain critical in memory function.

The researchers discovered that synaptic damage in the hippocampus was independent to the damage occurring to the myelin sheaths. Demyelination and axonal degeneration have been the focus of most current and emerging treatments for MS. The researchers were able to protect synapses in the hippocampus from damage after blocking a molecule called platelet-activating factor receptor (PAFR). The team is hopeful that this finding could open the door to neuroprotective treatments for MS in the future.

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Learn multiple sclerosis with the power of comics 7 comments

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Suzi Q 38

Thank you for the informative article and cartoon explanation.
I feel that developing MS would be horrible.

I have been diagnosed with a severe cervical spine injury that the “experts” said could have been MS.
I almost was not allowed to follow through with my cervical spine surgery because an MS doctor, the neurosurgeon, and a neurologist thought that the MRI and my clinical symptoms all pointed to this condition.
Another neurologist had a completely different opinion, as did I. We thought it was a mechanical problem with my c-spine, which necessitated a cervical spine surgery, STAT.

If I had proceeded with the surgery and my condition worsened anyway, I would have been diagnosed with the primarily progressive MS and the surgery would have been done for NOTHING. If it was NOT MS, and I did not have the surgery, I could be a quad with the next injury, neck twist, or fall.

What a decision I had to make in a short time.

Anyway, I got a “taste” for what it was like to have to face a future with this disease in my late-fifties.
I had watched a non-related family member die a slow death for ten years when he developed MS in his late fifties.
His breathing ability faltered, and he refused further treatment. The last time I saw him, he was in a bed and was using oxygen. Before we returned from our vacation, he died.

I have another friend who had the relapsing remitting type of MS since her late twenties.
She slowly and progressively got worse, in spite of all the good treatment that she received from the local teaching hospitals and her own local neurologist. She was about to go on one of the newer medications for MS, but refused to take the drug for personal reasons. She started to get worse and worse, so she got so upset that she was a burden to her husband and everyone else that she took her her own life.

I don’t tell my husband, but the doctors say that they don’t THINK I have MS. They still are not completely convinced that I don’t. I refuse to be treated for MS until the experts can show me that I have it. Initially, the experts wanted me to go on a clinical trial, but I refused because the tests given to me were negative, and my motor function was decent.

Hi Suzi, thanks for sharing your experiences with us. MS can be difficult to diagnose with the symptoms being so variable and unpredictable. Hopefully as awareness grows and research is accelerated therapies may come to light to prevent MS from affecting future generations.

Michael

Thank you for sharing such an interesting story. I wish you the best of luck!

MDgrow

I find it excellent what you are doing Jorge. I think that medical education needs to be revolutionized and disrupted. What a good way of offering new ways to learn for students. I wished someone would have came up with something like this when I was a medical student studying for the usmle’s. It is great to have people like you and keep innovating man..